Professional Documents
Culture Documents
Rev. 00 – 03/01/17
APPLICATION FORM
REFERENCE NUMBER : HIL 1 8 0 1 5 5 1 4 2 0 0 0
Qual – YY Region Province Number Series Number Series
alpha
code Assigned to AC PICTURE
UNIQUE LEARNERS IDENTIFIER (ULI):
colored
- - - -
passport size,
to be filled – out by the Processing Officer
white
background
Applicant’s Signature Date of Application
SURNAME
FIRSTNAME
MIDDLE
MIDDLE INITIAL
NAME EXTENSION
(e.g. Jr., Sr.)
NAME
Mailing 1
2.2.
Address:
Number, Street Barangay District
Pangasinan 1
City/Municipality Province Region Zip Code
2.3. Mother’s Name 2.4. Father’s Name
2.5. Sex 2.6. Civil Status 2.7. Contact Number(s) 2.8. Highest Educational 2.9. Employment Status
Attainment
Male Single Tel: Elementary Graduate Casual
Female Married Mobile: High School Graduate Job Order
Widow/er E-mail: TVET Graduate Probationary
Separated Fax: College Level Permanent
College Graduate Self - Employed
Others:
Others: ____________ OFW
Birth
2.10 Birth date (mm/dd/yy): M M D D Y Y 2.11 2.12 Age:
place:
3. Work Experience (National Qualification-related)
3.1. 3.2. 3.3. 3.4. 3.5. 3.6
Monthly No. of Yrs.
Name of Company Position Inclusive Dates Status of Appointment
Salary Working Exp.
ADMISSION SLIP
REFERENCE
NUMBER :
HIL 1 8 0 1 5 5 1 4 2 0 0 0
SHALLIMAR R. ALCARION
Printed Name & Signature of Processing Officer Printed Name & Signature of Applicant
Date: Date:
Reference No.
to be filled out by the Processing Officer
Qualification:
Units of Competency
Covered:
Instruction:
Read each of the questions in the left-hand column of the chart.
Place a check in the appropriate box opposite each question to indicate your
answer.
Can I? YES NO
I agree to undertake assessment in the knowledge that information gathered will only be
used for professional development purposes and can only be accessed by concerned
assessment personnel and my manager/supervisor.
___________________________________ Date:
Candidate’s Name & Signature
Evaluated by:
_______________________________ Qualified for Assessment
AC Manager
Not yet Qualified for Assessment
Date:
TESDA-OP-CO-05-F31
Rev.No.00-03/08/17
ATTENDANCE SHEET
(Title of Qualification)
Name of Competency
Assessment Center:
Date of Assessment:
No. CANDIDATE’S NAME Reference Number: Signature Assessment Results
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Assessor/s:
TESDA Representative:
__________________________________
Signature over Printed Name ______________________________
Signature over Printed Name
Accreditation Number:_______________
AC Manager:
__________________________________
Signature over Printed Name ______________________________
Signature over Printed Name
Accreditation Number:_______________
TESDA-OP-CO-05-F28
Rev.No.00-03/08/17
LETTER OF APPOINTMENT
_______________
Date
___________________
___________________
___________________
Dear Sir/Madam:
______________________
AC Manager
Conforme:
_____________________
Signature of Assessor
TESDA-OP-CO-05-F30
Rev.No.00-03/08/17
NAME OF ASSESSMENTCENTER
DATE OF ASSESSMENT
REQUESTED BY
(PO CAC Focal)
DATE OF REQUEST
APPROVED BY
(Provincial Director)
DATE APPROVED
TESDA-OP-CO-05-F29
Rev.No.00-03/08/17
LETTER OF ASSIGNMENT
_________________
Date
___________________
___________________
___________________
___________________:
This letter officially designates you as TESDA Representative on (__Date __) for (
Title of Qualification ) at ( name and address of AC/AV ). Please report
to the Assessment Center/Venue as scheduled.
If you have any questions/ queries, please call the undersigned at telephone
number/s ______________.
____________________
Provincial Director
Conforme:
_____________________
Signature over printed name
of TESDA Representative
TESDA-OP-CO-05-F34
Rev.No.00-03/08/17
____________________________________ _____________________
Signature over Printed Name (TESDA Rep)
TESDA-OP-CO-05-F35
Rev.No.00-03/08/17
LETTER OF DESIGNATION
_______________
Date
Dear ________________:
___________________ _____________________
AC Manager TESDA Provincial Director
CONFORME:
___________________
Head, TVI/ Company
TESDA-OP-CO-05-F36
Rev.No.00-03/08/17
ASSIGNMENT OF ASSESSORS
For the month of ____________________
QUALIFICATION PROVINCE
TITLE
NAME OF ASSESSOR ASSESSMENT CENTER DATE OF
ASSESSMENT
TESDA-OP-CO-05-F37
Rev.No.00-03/08/17
Performance Evaluation Instrument
Assessor’s Name
Qualification
Date
Name of Respondent
Accomplished
[Pls. Tick () where applicable]
ACAC Manager Candidate
INSTRUCTIONS: Put a tick () mark in the appropriate column
5– Very Satisfactory 3 – Good
SCALE GUIDE 1 – Poor
4 – Satisfactory 2 – Fair
RATING
ITEM
5 4 3 2 1
1. Physical appearance and composure
(Pangkalahatang anyong pisikal at kung paano magdala sa sarili)
2. Ability to pace instruction
(Kakayahang magpaliwanag ng malumanay at mahusay kung ano ang
mga dapat gawin)
3. Ability to establish good rapport with candidates
(Kakayahang magpadaloy ng komunikasyon sa pagitan niya at ng mga
kukuha ng pagsusulit)
4. Ability to ensure that the candidate understands the instruction
(Kakayahang siguraduhing ang lahat ng instruksyon ay naiintindihan
ng mga kukuha ng pagsusulit)
5. Ability to answer querries, comments, etc.
(Kakayahang magbigay ng karapat dapat nasagot o tugon sa mga
tanong, puna o mga paglilinaw)
6. Ability to establish the assessment context and purpose of
assessment
(Kakayahang magpaliwanag tungkol sa layunin ng pagsusulit)
7. Ability to plan and prepare the evidence gathering process
(Kakayahang paghandaan at iayos ang mga pangangailangan sa
pagsusulit)
8. Ability to provide allowable/reasonable adjustments in the
assessment procedure
(Kakayahang magbigay ng makabuluhang konsiderasyon sa may
Mga pangangailangan sa pagsusulit)
9. Ability to conduct assessment in accordance with the
methodologies
(Kakayahang ipatupad ang pagsusulit ayon samga itinakdang
panuntunan)
10. Ability to collect appropriate evidence during the conduct of
assessment
(Kakayahang mangalap at sumuri ng mga tamang ebidensya
habang nagbibigay ng pagsusulit
11. Ability to provide clear and constructive feedback on the
assessment decision
(Kakayahang magbigay ng malinaw at tamang kaukulang opinyon
sa resulta ng pagsusulit)
EVALUATOR’S REMARKS:
RECOMMENDATION:
YES
For re-accreditation For further review
NO
*Frequency
For AC Manager – once a month
For Candidate - at least 2 candidates per assessment schedule
TESDA-OP-CO-05-F38
Rev.No.00-03/08/17
LETTER OF AUTHORIZATION
__________________________
Signature of the Certified Worker
__________________________
Authorized Representative
(Signature over Printed Name)
___________________________________________________________________
For TESDA use only
__________________________________
TESDA PO CAC Focal person
(Signature over Printed Name)